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The Reality of Trump’s Work Requirement Order

The White
House’s most recent move to add work requirements to welfare programs may do
little to alter Medicaid.

President
Donald Trump looked to strengthen his administration’s plans to add work
requirements to welfare programs, including Medicaid, in an executive order
signed recently.

The order directs the Department of Health and Human Services and
other agencies to give more flexibility to states to install work requirements
in their public assistance programs, strengthen existing work requirements, and
review their existing guidance and regulations to ensure they’re pushing people
in these programs into employment programs.

However,
one critic of the Trump administration told me the federal government has
already done just about everything it can do to permit states to install work
requirements in Medicaid programs across the country.

“There’s
nothing more they can do; they’re already allowing the most draconian policies
imaginable,” Sara Rosenbaum, a health policy professor at George Washington
University who is part of a lawsuit challenging the work requirements installed
by Kentucky, said.

Jeff
Myers, president and chief executive officer of Medicaid Health Plans of America, told
me he’s hoping the order prompts states seeking permission to install work
requirements in their Medicaid programs to think more broadly about their programs
serving the poor. He said many states want to combine insurance, housing and
transportation programs to better tackle the issues poor people face, but they
face policy barriers that prevent mixing of federal dollars for separate
programs.

“An
optimist could see it as a mandate from the president to think through
anti-poverty programs in a far-more comprehensive manner,” he said.

After
releasing the order, Trump administration officials specifically noted there
are over 74 million people enrolled in Medicaid and the Children’s Health
Insurance Program, an all-time high. The two programs are among the largest
under the HHS, but the agency also oversees Temporary Assistance for Needy
Families (TANF), which gives poor families financial aid; programs that give
financial assistance to low-income families who are struggling to afford home
heating costs; homelessness initiatives; and foster care programs.

The Trump
administration has already started allowing states to consolidate public
assistance programs into “welfare-to-work” demonstration programs, Steve
Wagner, acting assistant secretary at the HHS’s Administration for Children and
Families, said in a statement. The order is meant to expand on that authority,
he said.

Wagner
said his agency in coming months will issue new policy guidance and research on
work requirements for other programs.

The Trump
administration has been signaling since early 2017 its willingness to allow
states to test new models in their public health insurance programs for the
poor that include work requirements for beneficiaries. Three states—Arkansas,
Indiana, and Kentucky—have installed work requirements for their Medicaid
recipients, and seven more states have pending requests for similar
requirements.

These changes are central to Republican efforts to remake
Medicaid, which expanded coverage in 32 states under the Affordable Care Act,
and restrict the program to those who can’t find employment because they are
elderly or disabled, or are children. However, critics have noted, new requirements
bring administrative burdens as well.

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